Session Information
Session Type: Abstract Submissions (ACR)
Risk of Cardiovascular Events in Patients with Psoriatic Arthritis, Psoriasis, and Rheumatoid Arthritis: A general population-based cohort study
Background/Purpose: Psoriatic arthritis (PsA), psoriasis, and rheumatoid arthritis (RA) are associated with an increased risk for major adverse cardiovascular events (MACE; myocardial infarction (MI), cerebrovascular accidents (CVA), and cardiovascular death) but are also associated with traditional cardiovascular risk factors (TCVRFs). Little is known about the risk for MACE in patients with PsA after adjusting for TCVRFs or relative rates of MACE among these 3 diseases. We aimed to determine the risk of MACE among patients with PsA compared to psoriasis without known PsA, RA, and the general population after adjusting for TCVRFs.
Methods: Longitudinal cohort studies were conducted for the following outcomes: cardiovascular death, MI, CVA, and MACE (composite outcome). Data from 1994-2010 from The Health Improvement Network (THIN), a primary care medical record database in the United Kingdom, were included. Patients aged 18-89 were selected if they had a diagnosis of PsA, RA, or psoriasis (PsA, RA, psoriasis, MI, and CVA have been validated in THIN). Up to 10 unexposed controls matched on practice and start date within the practice were selected for each patient with PsA. Cox proportional hazards models were used to calculate the relative hazards for each of the outcomes adjusted for TCVRFs (age, sex, diabetes, smoking, hypertension, hyperlipidemia) and additional confounders which changed the main effects by >10%. A priori we hypothesized an interaction between disease status and disease modifying anti-rheumatic drug (DMARD) use and this was significant (p<0.02) for all endpoints.
Results: Patients with PsA (8,706), RA (41,752), psoriasis (138,424) and unexposed controls (81,573) were identified. After adjusting for TCVRFs, the risk of MI was increased in all disease groups although not statistically significant in patients with psoriasis without a DMARD prescription. The risk for MACE was increased in all disease groups but not significant in patients with PsA not prescribed a DMARD. These results were not affected by sensitivity analyses varying definitions of the outcomes, restricting to patients followed regularly, utilizing multiple imputation for smoking and body mass index, and imputing additional DMARD users.
Conclusion: Patients with PsA, psoriasis, and RA are at increased risk for MACE, particularly MI, compared to the general population but patients with RA and severe psoriasis have a substantially higher risk than unexposed controls.
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Table. Incidence Rate and Hazard Ratios (95% CIs) for Major Adverse Cardiovascular Events |
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COMPOSITE OUTCOME |
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Incidence per 1000 PYs |
Age-Sex Adjusted HR |
Fully Adjusted* HR |
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|
Unexposed |
5.03 |
Ref |
Ref |
|
|
PsA |
No DMARD |
6.76 |
1.34 |
1.24 |
|
|
(1.13-1.58) |
(1.03-1.49) |
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DMARD |
4.61 |
1.15 |
1.16 |
|
|
|
(0.94-1.40) |
(0.93-1.43) |
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RA |
No DMARD |
13.54 |
1.43 |
1.38 |
|
|
(1.33-1.53) |
(1.28-1.50) |
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DMARD |
11.09 |
1.62 |
1.57 |
|
|
|
(1.51-1.74) |
(1.50-1.70) |
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Psoriasis |
No DMARD |
5.41 |
1.17 |
1.08 |
|
|
(1.11-1.23) |
(1.02-1.14) |
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DMARD |
6.50 |
1.31 |
1.31 |
|
|
|
(1.13-1.52) |
(1.12-1.53) |
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MYOCARDIAL INFARCTION |
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|
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Incidence per 1000 PYs |
Age-Sex Adjusted |
Fully Adjusted* |
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Unexposed |
1.96 |
Ref |
Ref |
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PsA |
No DMARD |
3.02 |
1.46 |
1.36 |
|
(1.15-1.87) |
(1.04-1.77) |
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DMARD |
2.28 |
1.33 |
1.34 |
|
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(1.01-1.76) |
(1.00-1.81) |
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RA |
No DMARD |
4.23 |
1.36 |
1.33 |
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(1.21-1.54) |
(1.17-1.51) |
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DMARD |
4.87 |
2.02 |
1.96 |
|
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(1.82-2.24) |
(1.75-2.19) |
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Psoriasis |
No DMARD |
2.20 |
1.18 |
1.07 |
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(1.09-1.29) |
(0.98-1.17) |
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DMARD |
2.67 |
1.36 |
1.31 |
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(1.09-1.71) |
(1.03-1.65) |
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*The fully adjusted model includes Age, Sex, Diabetes, Hypertension, Hyperlipidemia, Start Year in the Cohort, Smoking Status †DMARDs included azathioprine, leflunomide, hydroxychloroquine, chloroquine, methotrexate, sulfasalazine, mycophenolate, adalimumab, etanercept, and infliximab. Patients with psoriasis were considered to be on a “DMARD” if they had been prescribed etretinate, acitretin, hydroxyurea, PUVA or phototherapy. |
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Disclosure:
A. Ogdie,
None;
Y. Yu,
None;
K. Haynes,
AstraZeneca, Bristol Myers Squibb,
9;
S. Maliha,
None;
T. Love,
None;
A. Troxel,
None;
S. Hennessy,
None;
D. Margolis,
None;
S. Kimmel,
None;
N. N. Mehta,
None;
H. Choi,
None;
J. Gelfand,
Amgen, Abbvie, Novartis,
2,
Amgen, Abbvie, Novartis, Jansen, Celgene, Merck, Eli Lilly, Pfizer ,
5.
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